Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Saturday, July 26, 2008

Warning. Reading this will be a lot like watching a car crash. If you start you will want to stop, but you will not be able to. This is cobbled together from an overnight shift patient who had eloped from the ER, and then called the ambulance to come back in. She did not get the MDOD award for the night, in fact, she came in fourth, but she was the only one on whom I took shorthand. Please excuse the lack of narrative direction, I think you will follow the conversation without it (and oh, by the way, this is not edited to make the patient seem worse... in fact, it is edited with grammatical corrections in place, the 'uh's and 'ummm's deleted, and a partial, but completely true medical history).

Hey I'm 911doc, how can i help you?I've got jiggers and I'm in a lot of pain all over.

Weren't you seen here earlier today?Yeah, but I prayed and it went away so I left.

Did you just call the ambulance to come in?Yeah, the pain came back and I got scared and I didn't think I should drive.

My nurse tells me you've had pain for a year?Yeah, but it's worse today. About six months ago I was supposed to have some kinda scope or something, but that was when I had insurance... I don't have a doctor, I was supposed to have a scope but I couldn't go.

It says here you were throwing up blood?Earlier I did, at least I think it was blood, it looked brown, I got really concerned, and I haven't had my stuff done.

What stuff?That scope thing, I didn't do it.

Why didn't you do it?'Cuz I had a real bad breakup, I was so depressed I didn't go... I did have insurance then, but I don't now. I don't know why I needed that scope anyway... I don't do the anal stuff, so I didn't get all tore up inside, but sometimes when I sit down it really hurts and I want to know what's going on... it keeps going on.

Seems like you are quite comfortable now...But the pain is coming back and it's in my legs now.

Have you had any vaginal or anal bleeding or discharge?No.

Are you pregnant?No.

Have you ever been pregnant?Yes, four times, but i don't have any children.

What happened?I terminated them.

I see. Do you use drugs or alcohol?No... the pain is so sharp it hurts to go to the bathroom.

You said it hurts all over...Yes, I have no idea what it is.

Do you have any allergies?Yeah.

To what?Some 'antibiotic'.

Do you have any other medical problems?Yeah, six years ago something happened and I was like The Nutty Professor... they said I had angioedema so I had to wear a mask. I was on all kinds of medication, I was on steroids for a long time, years ago, I was having headaches, the pain got really bad so I couldn't sit then I started throwing up.

Hmm.... unless you had a bad allergy to something wearing a mask doesn't make any sense for angioedema.

I had to wear a mask.

Hmm... the most concerning thing you told me is that you had blood in your vomit. We are going to have to find out what it is... if it's blood then we need to get you admitted.I took two laxatives they didn't work.

Hurting this much is not constipation, besides that, laxatives don't work right away... I need to order some tests...My stomach is bubbling and I can't go to the bathroom and feel like I'm going to throw up.

How many times have you vomited?Twice.

Who is your doctor?I don't have one because I was on depo.

You don't have a doctor because you were on depo?Well I stopped taking it because my blood pressure went up and then he wouldn't see me.

20 comments:

I can't even believe people like this exist. I mean, obviously I believe it because you are telling me but I just can't understand why people would act that way.

I too thought she would end up being pregnant though.

I have an awful sunburn today because we were at the beach yesterday and although I sunscreened all my kids and none of them are burnt, I didn't do a good job on myself. Perhaps I should call an ambulance? I mean, I THINK the sunburn is from the beach, but you never know, right?

This bill actually seems sort of low...I think a few charges were forgotten:

*The 10 sandwiches she ate. While her budget allows for the almighty fine Columbian "booger sugar" it does not allow enough left over to feed herself. And we all know that for every patient that presents to the ED for an abd ailment......getting fed is their most pressing agenda

*Her disability check. When I lived and worked in the People's Republik of Seattle, I had actually had many of my overdose patients mock me with the fact that they used their disability checks (addiction was a disability there) to, obviously buy drugs. As my patients would so eloquently put it, "you are paying for me to get high sucker"

*The almighty taxi voucher. While I use a train and a bus to get to work (can't afford cabs) my patients usually regards themselves as above such base means of transportation.

I think that should add at least another grand on there!

I also thinks it's ironic that the first thing I thought of was "at least she's not pregnant"

Dont worry about Bernadette, shes from Northern California if you know what I mean. Gonna piss some people off here, but at least Ms Formication had the sense to avail herself of the latest in Pregnancy Termination Technology. Its like looking at the NCAA basketball brackets. Her 4 spawn multiply into a small Alabama town inside of 30 years.

i must say that as i was in the middle of another night shift from hell courtesy of 'non-creepy' politics that her comment took me a bit off guard. in fact, between her two comments i believe she might have indulged in some fine northern cali. sinsemilla. just sayin'...

and obtw, you seem to have a real love-hate thing with old alabamee... auburn football? come on over to the georgia side of the aisle... you live there (but are probably sick of all the uga fair weatheres in a-town).

hopefully will be a great year for them if knowshon doesn't get hurt and curran and stafford play up to speed. check out curran on edsbs a week or two back... the guy can clean and jerk about three ford pickups. he drills people too.

that being said, georgia will lose to auburn at auburn and one or two others and socal and the ohio state university will probably play for it all.

911, I explained it to my wife like this, Alabama's Iran/Iraq/PLO all rolled into 1, Auburn's Israel, and UGA's the US. I agree with you on your Auburn/Georgia pic but for a different reason. Whenever its an Odd-Numbered UGA in his first even numbered year as Mascot, the War Eagles win...

dang... it is possible to be cynical/ uncaring in a selective kinda way...AND a liberal?YES.. if you live in northern california and smoke pot, i guess.

gasp. sometimes i must admit that the 2 seem kind of mutually exclusive.undoubtedly, the warped view of the world you get after 20+ years in e.r. can't help but open your eyes to the big, scary,fucked up world. the creepy politics reflect my vibe that your razor sharp assessment skills used to distinguish thebig bullpucky from the little bullpucky has soured your worldview. i mean, even if there are tons of lazy, dependent,leeches out there; we still need a society that somehow cares and tries to give the folks some basic tools.

Yes, theres never been a shortage of stupid people, but in the old days they helped build pyramids and transcontinental rail roads. Thats the dirty little secret about the illegal immigration situation. The Mexicans are Einsteins compared to our home grown idiots.

My trips to the ER are blessedly rare -- but every time I witness a drug addict trying to get painkillers from a resident. As an old experienced lady I can spot that addict in two minutes. Why can't the residents? And when it happens does the file get marked?

I can believe this story, Iwas an addict to meth for mant years. I walked away from it, it can be done. I seen people like this, I may have even been like this. It is sad. we have a problem here in the U.S.. And we need to do something about soon.

I can't figure what Bernadette is talking about and not only am I from Northern California, but I'm also from SAN FRANCISCO! I don't smoke pot by the way. Nor am I "political".

I've only been to the ER once in my life, but I work in a profession where I have to read medical records sometimes and it amazes me how many people go to the ER on a regular basis because they did something like sprain their ankle. I sprained my ankle two weeks ago, but I wouldn't dream of bothering the folks in ER about it. Isn't ER supposed to be about life threatening problems?

if you read a bit more here you will see that, sadly, the ER is where people go at all hours for shit that mom's used to take care of at home or people used to take care of themselves.

sometimes they come in because they are lonely and many times they come in with an agenda... they are lying to get drugs.

these are the worst as we end up spending huge amounts of money to address the complaints... 'chest pain', 'abdominal pain', 'back pain', 'pain for 8 years worse tonight', and since the govt. passed EMTALA (search blog, we talk about it a lot), there is no downside or bad consequence for these abusers.

worse, they often call 911 and ride the ambulance in because it's cheper for them than driving. NOT a rare event. YES, it happens all the time everywhere in the states.

I do like your blog, it was great. Sadly there are people out there like that. I have been accused of being a drug addict because I spent several months back and forth to the ER due to dental problems. I did not have insurance at that time, I was still in the 90day probation time at my work. I had my wisdom teeth come in and became impacted. During my 6th visit to the ER in 3 months, because the pain was just too much for me to handle, the nurse said that I had been in here too much for pain medication and she was calling the police because I was trying to hussell drugs???. Side note, they only prescribed me about a weeks worth of pain killers, and I split the hydrocodine in half to make it last longer. I am very sensative to it, so I tried not to take that much of it. Well, I was crying in the hall on the gurney (all the rooms were full) in pain and scared out of my mind that I was going to get arrested. The police came in, asked if I was in pain and then turned to the nurse and proceded to chew her out. I had no reccord, and all my tests were clean. A dentist came in did some exrays and also chewed the nurse out. The only thing she did was see my chart, the fact that I had been very active at the ER and assumed that I was an addict. Needless to say she was fired, and b/c the ER did not want any problems the Dentist got my wisdome teeth out. I don't go to the ER unless I am dying now. But I really do like your blogs, I think they are great, funny, and show the real human side of life. You can't always be nice to people even if you are a Dr. or nurse.